NPIMap

Organization Active NPI

Sand Plastic Surgery, PLLC

  • Ambulatory Surgical Clinic/Center
  • Spokane, WA
National Provider Identifier
1851055362
Registry record updated Nov 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
SAND PLASTIC SURGERY, PLLC
Practice address
307 W 6TH Ave Ste 200
Spokane, WA 99204-2502
Phone
(509) 324-2980
NPI assigned
Oct 30, 2021
Reactivated
Nov 3, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jordan Paul Sand, MDNPI 1417243668
Title
Owner
Phone
(509) 324-2980

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

307 W 6TH Ave Ste 200
Spokane, WA 99204-2502

Mailing address

307 W 6TH Ave Ste 200
Spokane, WA 99204-2540
Phone (509) 324-2980

Other names 1

  • Sixth Avenue Surgery Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221221000707 WA Part B Supplier - Ambulatory Surgical Center 2163803628 Practice locations: Spokane, WA

Ambulatory surgical center certification: CCN 50C0001344

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
Sixth Avenue Surgery Center
Certification status
Active
Provider type (POS)
Ambulatory surgical center
Participating since
Jan 9, 2024
Last certification
Jan 9, 2024
Ownership / control type
Proprietary
Facility address
307 W 6th Ave Ste 200
Spokane, WA 99204

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D2273935Sixth Avenue Surgery Center307 W 6TH Ave # 200, Spokane, WA 99204Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory
Tax ID family
Sand Plastic Surgery2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

307 W 6th Ave
Spokane, WA 99204
Phone (206) 690-5962

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1635552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699833600000",
    "number": "1851055362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 W 6TH AVE STE 200",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992042540",
            "telephone_number": "509-324-2980",
            "fax_number": "509-418-9462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 W 6TH AVE STE 200",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992042502",
            "telephone_number": "509-324-2980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAND PLASTIC SURGERY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-30",
        "last_updated": "2023-11-13",
        "certification_date": "2023-11-13",
        "deactivation_date": "2022-11-25",
        "reactivation_date": "2023-11-03",
        "status": "A",
        "authorized_official_last_name": "SAND",
        "authorized_official_first_name": "JORDAN",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "509-324-2980",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sixth Avenue Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sixth Avenue Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Spokane, WA

Sources for this page

Verify at the official NPI Registry.